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5r- Will the project: <br /> a . generate oLjectional odors : v <br /> b. generate any discharge into surface waters: <br /> c . generate or store hazardous materials: Z7,7, <br /> d. expose people to any hazardous materials or situations: <br /> e . displace people:_ A/0 <br /> f . use significant amounts' of energy or natural resources : <br /> g . cause congestion on roadways or at interchanges or intersec- <br /> tions: p <br /> ❑ SIGNATURE <br /> I certify under penalty of perjury that I am (check one ) : <br /> Legal Property Owner (owner includes partner, trustee, trustor , or <br /> corporate officer . ) <br /> LJ Owner ' s legal agent (attach proof of the owner 's consent to file <br /> the application ) , <br /> and that the foregoing is true and correct . <br /> (Signature ) (Date ) <br /> Minor Subdivision - 10 - ( 6/86 ) <br />